Obsessive-compulsive Disorder. "Fool Your Brain"

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Fool your brain because it deceives you.

Without going into the medical definition of OCD (there are many of them in the public domain), consider a visual, metaphorical representation of the essence of OCD.

“On a completely empty square, in the center of a modern European city, a man stands and occasionally claps his hands. A curious passer-by comes up to him and asks. Why are you clapping your hands. The man answers the passer-by - I drive away the elephants. Then a passer-by asks him a logical question, but there aren't any elephants here.? Therefore, they are not there - the person answers the passer-by."

At first glance, it would seem that we are faced with a man who has "not all of his homes." And what he does is really absurd. But this is just our view of the situation.

If we ask this person, does he understand that everything he does is at least absurd and he does not disperse any elephants? He will answer us. That of course he understands that he is doing it in vain and understands the absurdity of his actions. But if you only knew for sure? And since I do not know this, if I do not do this, I will be very anxious and I will think about it and until I pat, I will not calm down.

This is what OCD looks like from two different angles.

From the side of other people (external view) and from the side of the person himself (view from the inside).

Very often, people looking from the outside cannot understand the meaning of the actions of a person with OCD, since for them it defies rational explanation. Attempts to convince a person of the absurdity of his actions from the point of view of rationality and logic do not succeed, because a person understands the irrationality of his actions himself, but his logic is his own OCD logic.

In other words, Obsessive-Compulsive Disorder is a prison for the mind. Moreover, a person builds it himself, repeating his own behavior, in order to "neutralize the threat." At the same time, he is sure that this should be done and only because it works well. It helps.

In this way, in a very simple and logical way, at first glance, an initially rational action, with its repeated and systematic repetition, quickly turns into an absurd tyranny of oneself.

Let us consider OCD from the point of view of a psychological phenomenon, what is it, how difficult it is, and what to do?

For the sake of fairness, it should be noted that the description of OCD through the presence of obsessive thoughts (obsessions) and obsessive actions (compulsions) is too simple and short for such a complex and multifaceted disorder.

To visualize the complexity of OCD, for example, as opposed to phobic disorders can be represented as the difference between an emoticon and a mandala.

Typologies of obsessive-compulsive disorder:

The unjustified becomes “reasonable”

The first typology includes all cases of OCD associated with the fear of contracting a disease through contact.

Protective behavior consists in ritual disinfection of hands, rooms or individual places, frequent washing of clothes, forcing loved ones to comply with the hygiene rules established by the patient.

Temple of purity and order

This type of disorder is very similar to the first. But, there is no fear of infection with something specific. The main protective behavior will be the ritual restoration of order. Thorough cleaning of the apartment for several hours a day, to such an extent as to be sure that not a single millimeter of uncleaned space remains. For the preservation of cleanliness and order, various rules are used that all family members must follow.

Monitoring the safety of finding items in their places, constant checks and unfolding items, in certain places for them, according to colors, sizes …

Do not believe your eyes

A type of OCD that is characterized by constant doubt about one's own actions.

It consists in repeated ritual checks of various circumstances, which can lead to undesirable or dangerous consequences.

Checks of window handles, stoves, various water and gas valves, door locks, car locks, electrical appliances.

This type also includes multiple checks of normal actions. For example, multiple opening / closing of the laptop lid. Checking the written text, closing Internet pages, checking if the items you need are in your bags. (phone, passport, keys). Repeated checks of alarm activation and so on …..

Superstitious belief

This type of disorder is based on a fear of guilt or punishment for negative, obscene, unacceptable, blasphemous thoughts.

Very often this type is found among believers. The appearance of blasphemous thoughts in them is assessed as a serious sin and provokes them to pacify their sin by performing various rituals (non-religious) and / or by fervent prayer.

But a person does not have to be a believer in a religious sense. It is enough to be very superstitious. A characteristic feature of this type is the formula "If I do not do this, then something bad will happen." or "If I thought bad, then something bad will happen."

Note: A characteristic feature of this type is the belief in the materiality of thought. But this is optional.

Trauma violence

This type is characterized by rituals of purification, associated with sexual abuse.

Wash off the feeling of "dirt" and calm down.

Pathological doubt

A separate typology, which is included in the concept of obsessive-compulsive disorder, from the point of view of medical classification and diagnosis, but does not have its own separate status, is characterized by obsessive doubt.

(in the second part of this article, I will give clinical examples for each of these typologies).

Very reliably, some types of OCD can be seen in films.

For example:

"Aviator" - Leonardo DiCaprio (directed by Martin Scorsese, USA-Japan-Germany, 2004) - the type "the unjustified becomes" reasonable ".

"It Couldn't Be Better" - Jack Nicholson (Dir. James Brooks, USA, 1997) - the type "the unjustified becomes" reasonable "," superstitious belief ".

“The Magnificent Scam” - Nicolas Cage (Dir. Ridley Scott, USA, 2003) - a type of “temple of cleanliness and order”.

Excerpts from these films

Rituals (classification of compulsive actions).

It is extremely rare to have OCD without rituals. Or rather, it does not happen at all. Even if, at first glance, there are no rituals, it means there is something else. Something else, it can be mental rituals (for example, a prayer or a formula), if not, then there is a phobic form of compensation for anxiety (avoidance) and there is still a search. (search is a form of compensation for anxiety in pathological doubt).

The main characteristic of the ritual is inevitability and inevitability. It is impossible not to do the ritual and it is impossible not to complete it.

For the patient, the ritual is the only means of salvation, as it relieves anxiety. It "works" so well that, having arisen as a rational (or pseudo-rational) way, it turns into an independent problem.

For the therapist, ritual is a very important factor. This is a lever, by grasping which, we can quickly "destroy" the whole problem. The trick is to choose the right instrument for influencing the ritual. Unfortunately, there is no universal means of influencing the ritual. That is why rituals should be distinguished. Like the types of OCD, the rituals themselves have several characteristics. The type of ritual depends on the way it is destroyed.

Classification of rituals.

Quality and quantity

Rituals can be categorized as qualitative or quantitative.

Quantitative rituals are those in which the result is achieved by a certain number of repetitions. For example 3, 5 or 7. To distinguish a quantitative ritual from a qualitative one, it is enough to know that a certain number (no matter which one) of repetitions brings the desired result, even if this number may vary. Or the patient says that the number may be different, but did it several times and wants more.

For example: wash your hands 3 times. If I don't feel enough, I will wash it again or three more times. Touch the edge of the table 3 times

High-quality rituals - as a rule, such rituals take a fairly large amount of time, there is no clear and definite number of times in their structure, the completeness of the ritual is determined by obtaining a sense of satisfaction, the feeling that the ritual is performed efficiently. The structure of the ritual has its own algorithm and order of actions, there is repetition. But the result is assessed not by the number of actions, but by their quality.

For example: washing my hands in a certain way, but until you get a feeling of complete cleanliness. I wash very thoroughly, observe a strict order, wash off the soap until I get a feeling of complete cleanliness. (Such rituals can be from several minutes to several hours).

Quality or quantity are perhaps the only characteristics of the ritual that are relevant to therapy.

Rational or mystical

This is another characteristic of rituals, not related to quality and quantity. It is associated with a type of OCD.

If the action itself can be connected rationally with the consequences, then, accordingly, the ritual rational … For example: check the taps so as not to flood, check the door and windows so as not to get in. Wash your hands so as not to get infected.

Mystical, respectively, can be associated with the consequences only virtually.

For example: a prayer, touch the mirror, put slippers toes against the wall, wash off the "mental" dirt …., wash away the shame, guilt, wash hands, feet, part of the floor … so that none of the family members die or get sick with a terrible disease … and so on.

Warning, correction,

This is the division of rituals by vector. That is, conditionally, according to the answer to the question "for what?"

Rituals preventing the occurrence of any undesirable events.

For example. Disinfection of hands, objects, things. Establishing strict order. all by shelves, colors, sizes.

Correcting - wash away mental dirt, guilt, shame. Say a prayer after blasphemous thoughts, say a formula, a spell, look at three passers-by … after wishing death or illness, after unacceptable behavior, and so on …

To be continued…

Separately, real-life examples of OCD, from personal practice and for each type of disorder, will be given.

In second part I will dwell on pathological doubt ( as an illustration of PS - fears associated with sexual orientation "what if I'm gay? and others" and the differences between PS and the classic form of OCD. there will also be information about complex cases of OCD, bordering on paranoia and the peculiarities of psychotherapy for these states.

IN third part we will focus on disorders of the obsessive-compulsive spectrum and the characteristics of therapy. Hypochondria, dermatillomania, trichotillomania. Perhaps dysmorphophobia (but I do not have a personal example, I will take it from the practice of J. Nardone)

Therapy for obsessive-compulsive disorder, hypochondria, dermatillomania, trichotillomania, etc.